Seven wishes for the NHS on its 70th birthday

The future of the NHS relies not just on money and clinical expertise, but on whether it can exercise power differently.

As shown by this new set of blogs of voices from citizens and the frontline, reshaping power in health should be at the heart of the next chapter of the NHS.

Power in health is often assumed to be finite. So that calls for greater citizen power, for example, are often met with resistance - because if power is zero-sum, then citizens winning power must mean that clinicians lose power.

However, this is being challenged by increasing numbers of approaches which create shared power. In doing so, roles are changed, leadership is more distributed, decision-making is more deliberative and outcomes are more negotiated. But power is not lost, it is transformed.

Sharing power creates responses that are grounded in what matters to people and the realities of delivery. It helps create trust and engagement, which in turn will help renew the social contract on which the NHS is built. And it should enable the NHS to better adapt to the challenges and opportunities of population change, technology, data and advances in medicine.

So, on its 70th birthday, Nesta has 7 wishes for the NHS which focus on power. We believe that a more people-powered future of health and care has never been more important, and we hope that these wishes help create a stronger, more resilient NHS for the future:

1. Unlock the power of citizens

So that people feel confident and in control of their own health and wellbeing.

This means understanding what motivates each person and helping them to build confidence to move towards their own goals, such as cutting back on alcohol. This should include investing in networks, relationships and support that empower citizens and communities to have more say in their health and care, including the design of services.

2. Don't be afraid of empowering the frontline

So that health and care services are shaped by ‘on the ground’ experience of what works and what matters to people.

This means a health and care system that is willing to give frontline staff and citizens the permission and support to come up with new ways of doing things and to put these into practice. This means shifting from “top-down-only” reforms, towards a culture that actively encourages those closest to delivery to improve how services are run, collaborating across organisational boundaries, and with the support and encouragement of local leaders.

What Nesta is doing Nesta’s 100 Day People Powered Results method has shown the impact that a more diverse and shared power model can have on citizens, practitioners and the system.

3. Make the explosion in health data useful to citizens and the public good

So that the huge potential of data, held both inside and outside the NHS, is realised for the benefit of citizens, frontline staff and the public good.

This means creating ways for citizens and frontline staff to participate in the conversation about how data is used and to help build the technologies, platforms and knowledge they want. This should create new models of governance and ways to develop, use and validate data that enable citizens to be in control of their own data, and able to use it for their own health, in partnership with professionals and for the wider public good.

What Nesta is doing As part of our Centre for Collective Intelligence Design, we will be engaging citizens, technologists, regulators, policymakers and others to combine machine and human intelligence to improve health, including through new models of public involvement.

4. Champion ‘people-powered’ technology

So that Artificial Intelligence and other emerging technologies can support people to take more control of their health.

This means ensuring emerging technologies develop in ways that are beneficial for citizens, frontline staff and the public good. Digital technologies such as Artificial Intelligence could become a powerful intermediary in healthcare: giving advice before we see a professional or targeting care using predictive analytics. This could have tremendous benefits, but also brings very real risks. Developed badly, AI could give poor advice, reduce accountability or be a frustrating barrier to care.

What Nesta is doing Through research - such as Confronting Doctor Robot - working with regulators and developing practical programmes, we are helping to shape the reality of ‘people-powered’ technology. This includes working with citizens on the social and ethical issues of AI in health, using a variety of deliberation methods including digital tools.

5. Rapidly accelerate progress towards prevention

So that avoidable ill health is radically reduced through better knowledge about what works, including approaches based on social, behavioural and wider determinants of health.

This means matching the intent to prevent unnecessary ill health with the investment needed to make it happen. And recognising the critical role of community-based approaches, such as peer support. This would be boosted by the establishment of a new research institution, akin to the Francis Crick Institute on biomedical discovery. The institution should bring investment and leadership to strengthening and consolidating the evidence base across fields such as public health and the social and behavioural sciences.

What Nesta is doing Building on our NHS in 2030 report, we’re calling for a rebalancing of research and development investment in health towards social, behavioural and wider determinants of health. We also support promising approaches to be implemented alongside rigorous experimentation to generate useful evidence for practice and research.

6. Innovate in ways that are faster, smarter, more collaborative and more inclusive

So that new solutions for the health system are built on valuable insights from citizens, frontline staff and others often excluded from traditional innovation processes.

This means widening participation in innovation processes through open innovation methods, such as challenge prizes, and public engagement. The NHS should design new ways to do things in ways that tap into a wider set of insights and is grounded in the realities of delivery and in what matters to people.

What Nesta is doing Nesta’s Open Innovation in Health report set out the array of innovation approaches that are more open and participatory. Nesta’s Challenge Prize Centre has a number of health-related prizes including the Longitude Prize, which has an £8m payout for a winning team that helps tackle antimicrobial resistance through creating a new point-of-care test for bacterial infections.

7. Lead in ways that acknowledge uncertainty, surface tensions and build trust

So that the health and care system can grapple with competing demands and adapt for the future

This means recognising that the big challenges facing the system are ‘adaptive’ in the sense that they cannot be addressed using just today’s strategies, operating models and technical solutions. Addressing these challenges will therefore require leadership that acknowledges uncertainty, surfaces competing values and perspectives, builds trusting relationships and uses these to help create new ways of working across whole systems.

What Nesta is doing Our work actively supports a range of leadership approaches including adaptive leadership, civic leadership and ‘patient leadership’. Our People Powered Results work incorporates all these as well as supporting leadership for whole places and systems, rather than individual organisations.

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